Heart failure (HF) is on the rise in the elderly, and resources expended to treat the disease represent an increasing proportion of Medicare expenditures. Despite these trends, we know surprisingly little about HF in the elderly who develops the disease, whether treatment reflects evidence-based guidelines, how therapeutic services are used, and whether the therapies lead to improved outcomes. Our current understanding of HF in the elderly is limited by several factors. First, existing population-based views of patients with HF rely on geographically limited studies of relatively few patients. Second, detailed clinical guidelines for the management of heart failure exist, but it is unclear whether the care of elderly patients with HF, in fact, adheres to these guidelines. Third, a number of therapies have been associated with improved morbidity and mortality in the elderly, but the extent to which these therapies are being used in elderly patients is unknown. Fourth, we have little empirical evidence that the use of these therapies in real-world settings translates into improved outcomes. The objective of the proposed project is to improve our understanding of the aforementioned four issues. Our efforts are organized under four Specific Aims: Aim 1: To study the epidemiology of heart failure among the elderly, from 1997 through 2006, using a national sample of Medicare beneficiaries. Aim 2: To assess the use of guidelines-based care for the treatment of heart failure from the time of initial diagnosis through follow-up. Aim 3: To analyze the use of device-based therapies in the treatment of HF patients over time. Aim 4: To estimate the relationship between health care utilization and outcomes in patients with HF. We will accomplish these aims by conducting analyses of nationally-representative longitudinal data using analytic strategies developed by an experienced, multidisciplinary research team that reflects the perspectives of clinical cardiology, health services research, health economics, and statistics. At the conclusion of this study, we will have a comprehensive understanding of heart failure in elderly Americans and how investments in health care for patients with HF are directly linked to survival and health. [unreadable] [unreadable] [unreadable]